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Sullivan S 121 Signs
~ ~j~ ~ • {THIS IS NQT A PERM1T} BUiLain~~ ~~RMiT APPLicAYiON woRres~EET PLEASE PR1NT AND COMPLETE ONLY Ti-fC3SE PARTS C3F THE FORM YOD UNDERSTANi] GC3MPLETE IN IriiK (Please return tt►Is original and your riuitiding ptans to ihe DepartMerti of 8uilding and Safety) SHAaED AREAS ARE FQR dEPAflT'MEN`fAL USE Pru~ec~ ~►u~naer Ownef 51+1drne LA$7 FIRST MI 4L'~~ ~.l k-F,E-Xt Y "ecl aelelreSs (Street Warrre Fti Nu►nber) ` 2i¢ ti] t' ~ ~ ..~1.~ ~ ~ / L• f~11.b ~ ti ~ ~ v /-r- A - D 14L f= Apphr.anR 011dre,ss 5 / c - Cny - stale -Zip _ Pnoae / 6usiness Rhane t Ceirirr~arl Agern AdOress 4 Z7 I/ C14yf $1dl@ Z1 ft011e LiCe71se NIJf11Qo ({~t1 ►@dy ~1~9~R85S ~lptl@ ArcnttmF PEngtcYBef AGdfes5 ~ Giy te 7.~p Prroet& t 1 fontaE! Business Phone C 7 ten~`~r Address ~~tr Slate Zia Phanv I 1 Desaribe 1l+lark . comn C~ v LL - r SVDIj1MI8/0011PIA Na171$ISI10el Pft1 NUn1D8T' Assessor '34 sceT umber Lot 81o~#c fiat Number 6 V-,P& PMertrnsn! F}le Number8 ZemeCC" Camp riian Qonaua 7raei " F1ambor at {Wolfing UnFts Numberor eulMdinp Lo= sue (sq Fi aAcre) - oeptn fronf Wback Let} SetEaclc AiBht Selback . .s • ~ Ad~it~onai lhfar+a►atFoh ~ SqunreFoals~le . ~.,1 s .'t ~ • L`++i.y'.ti. ~ + s -w.a ■ 4 W ' ♦ ~ ~ ~ + 1 L _ n ~ • y # lY ~ ♦ n } 1 ° ~ ~ ~ ~ ~ LU , F ~ 4 • a t ~r cl T ~ ~ _ _ F J ~ Y f.~ ` . r • ~ ~ } +.r~ l ~ ~ f~i e ♦ 8v{tdng TechnlCiart _ O~1 q ptl+j+.s?~I4 a ~ ` 7R^'~'++~s~V+f+ 1 • _ ~J~ +~.7. ~ 1 _ 7 - J ~ 5 f 'r+ I ~ J DEPARTMENTAI REVIEW Approved Cond Nold , Approval 'Envi►anmenla) Health PermitlNumber ❑ w t t ot Col Iege - - Room 200 Pianning/Zoning ~ N 721 Jef terson - ~ _ - + E~ginee~s Permit Number ~ N 81/ Jefferson ~ j~s : be -ecwre*W s ;2; Utffitfes N,811 Jetterson Plan Revlew% Flre,Prevention N 811,Jef,ferson ~ - ~ ~ ti Other (SEPA/Critlcel Materlei/etc ) ~ Fast Treck/Speclal Inspection Inlormation - ProJecl Represenlative Phone Address Iicertily thal I have examined this application and state that the mbrmation contained,In ittand submitte0 by me,or m,y agent is true, correct. Ieget,Sand binding Owner's<Stgnatur,e Date ~ , 4 d ~ . ~s ~c ~0 ~ ~3~/~ , o ~C~r,~~vE ~ n r~ n ~ ~ ~ i ~ ~ ~ , r ~ ~ ~ ~ ~ ~ l ~ ~ ~ ~ ~ 1 ~ ~ , ' ~ • ~ ~ ~ Strow on Slte Plan Add(tlonal Intormation , _ ~ _ . . I , _ _ , , , -y- - ~ _ _ ~ _ _ . a ~ - ~ , ; . ~ , . r rn ~ landaca n ~ ' ~ ~ ~ ' ~ tot Olmenalon~ pl g ~ ~ - a-- . - ~ _ . _ . _ ' _ _ . Ezisting Structures Drainage Plan t , ~ r ~ i ~ ~ ~ Pro osed Im rovements H Oranb - - ~ - - ~ ~ ~ ~ _ ' P P Y - , _ ~ti - ~ . _ _ _ i r k To o ra h ~ ~,6 ~ ~ ~ ' ~ ' . 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